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Z, NVIRONMENTALWAIN-OF-CUSTODY RECORD B PROJ, CT <br /> (See Reverse for Instructions) NO <br /> PROJECT NAME SAMPLERS A Gt" � SAMPLE CONTAINER SAMPLE DESCRIPTION CODES TAT CODES <br /> (PRINT} ;/ DESCRIPTION CODES A Ground Water F Oil <br /> PROJECT NUMBER 6/-G'7,1 0oo I i! ' 1(-./ A 40-mlVOA Vial B Surface water G waste 1 Standard <br /> (SIGN) B Glass Liter E Brass Tube C Leachate H BlanklSpike 2 48 Hour <br /> RECORDER C Ptashc 500-mi F Other D Rmseate 1 Other 3 24 Hour <br /> (SIGN) D Plastic Liter E SoiilSediment 4 Other <br /> NUMBER OF ALYSIS REQUESTED LABORATORY USE ONLY <br /> CONTAINERS u <br /> m `o AND c F a ; <br /> =mm nm PRESERVATION °'m $ m <br /> 3 om LL� kz, SAMPLE <br /> a ii,- �= e F �`—<� NOTES ASSIGNED CONDITION <br /> DATE TIME SAMPLE ID E- n 2 w j1t `� f E >°V BOTTLE UPON <br /> y _ l N Z NUMBERS RECEIPT NOTES <br /> 11�51 7 115I1C F - I, 91A- <br /> I1_r591 5� f 1`'I- AE Y dY f v <br /> 3� 1 �rE ;L��� I7 n y �� ✓ ?�' <br /> VOW- 5 1 ✓ � <br /> 1 TS!MISCELLAN QUS ,�„ � � ,6 �f»r f) 'r� Iv ff ; Fhnq hep —(Su re) Received By (Signature) Date Time <br /> A I r0T-15 r,2) i ETE f A_r� � Relinquished By (Signature) Received By (Signature) Date Time <br /> ,,.. Relinquished By (Signature) Received By (Signature) Date Time <br /> Method of Ship ent Description of Other Chains-Of Custody Dispatched By (Signature) Date Time RbaB (Signature) Date Time <br /> Transport Container Transported with this d yS t <br /> Chain (by Serial No) f f 3 <br /> Ae /,NO�Send !_ab Results to (Name) (: '0 IJA)6: U�tt F ' (Check Office Below) Verbals Requests es 1-1NoEl <br /> ❑ ATLANTA ❑ DENVER ❑ IRVINE ❑ MT VIEW ❑ PORTER OTHER —� <br /> TEL(404) 9510055 TEL(303) 7901747 TEL(714) 757-1755 TEL(415)9601640 TEL(219) 926-8651 TE 'G <br /> FAX(404) 956 9364 FAX (303) 799 0186 FAX (714) 757-0960 FAX(415)960 0739 FAX (219) 926-7189 <br /> ❑ BOZEMAN ❑ HOUSTON ❑ KING OF PRUSSIA i ❑ PLEASANTON ❑ PORTLAND ❑ OTHER <br /> TEL (406) 586-9496 TEL (713)556-1666 TEL(215)337-2551 TEL (510) 463-9117 TEL (503) 2410282 TEL <br /> FAX (406) 586-9724 FAX(713)556-0666 FAX(215)337-0560 FAX (510) 463-2981 FAX (503) 2410486 FAX <br /> CANONIE ENVIRONMENTAL SERVICES, CORP • 6300 SOUTH SYRACUSE WAY, SUITE 300 • ENGLEWOOD, CO 80111 • TELEPHONE '303 290-8336 • FAX (303) 290-8013 <br /> SERIAL NO 14727 <br /> WHITE Field Copy YELLOW Project Capy PINK Laboratory Copy REV 8192 <br />